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Looking for a job the american revolution essay Extracting these present-on-admission cases, or POAs, from the case mix boosted patient safety scores for hospitals where such cases had previously exacted a penalty. Some hospitals achieved higher overall scores as a result and rose in the rankings, or displaced ranked hospitals that had been less affected by POAs and therefore gained less from the methodology change. Taking advantage of the POA exclusion requires hospitals to be diligent about identifying such patients and coding them appropriately. Hospitals that do not diagnose all POAs or that code them inaccurately not only derive no benefit from the change, but are penalized relative to hospitals that do better.